If you have chronic back pain, something's wrong...right? Maybe not. Sometimes, it might all be in your head... or at least, in the neurons of your brain. Listen in as neurosurgeon Dr. Erich Anderer explains how pain isn't that simple, and how incorporating ancient practices into modern therapies can help treat chronic back pain.
If you have chronic back pain, something's wrong...right? Maybe not. Sometimes, it might all be in your head... or at least, in the neurons of your brain. Listen in as neurosurgeon Dr. Erich Anderer explains how pain isn't that simple, and how incorporating ancient practices into modern therapies can help treat chronic back pain.
Dr. Erich Anderer:
A lot of times what happens is there's an initial impetus for pain, some something that causes you the pain, and then once that's taken away, there's this residual kind of neural pathway that continues and the nerves continue to fire, and they continue to send signals up your spinal cord and into your brain.
But what I'll then explain to them is that when I say it's in your head, I mean, it's literally in your head.
Narrator (Rose Reid): Pain is something we’ve all felt, whether it be a splinter, a bruise, a headache, or something more serious like an orthopedic injury or internal damage. The most common pain, however, the pain that’s to blame for the most lost days of work, the most immobility, the most psychological trauma, is chronic back pain.
Dr. Erich Anderer:
Back pain, spine pain is something that's so prevalent, I think we haven't really fully fleshed out the best way to treat these really, really common problems, and so, you know, what we're really fighting is like a battle against, like the way our culture has evolved.
My name is Dr. Eric Anderer. I'm the chief of neurosurgery at NYU Langone and Hospital Brooklyn.
Narrator: For Sirius XM and NYU Langone Health, This is Vital Signs. I’m your host, Rose Reid.
Dr. Erich Anderer:
I grew up in New York City, but I was actually born in Tokyo. My father is a professor of Japanese literature at Columbia University, uh, for many years. He actually recently retired. Um, and so, and my mother is a Japanese American, grew up in Chicago. So, uh, my household, even though I grew up in New York City, had a, I'd say, like, sort of a distinctly Japanese influence, um, you know, which basically I'd say permeated all aspects of my life. Um, even to, you know, our, our first touch with healthcare.
We would have a primary care physician. But in addition to that, um, because, uh, you know, he wasn't always able to get to, um, a primary care physician. Uh, we, we actually had a, a reiki practitioner, uh, who was a friend of the family that helped us sort of almost acted like a primary care physician for us.
I'm certainly no expert in Reiki, um, but it's sort of like an ancient Japanese healing art. And so the, uh, the practitioner that we went to was somebody that was very sort of facile with massage, uh, shiatsu massage, but she also, she was a healer and a lot of reiki, a lot of the principles in Reiki revolve around self-healing. So being able to kind of have a sense and awareness of your own body and it's generalized health.
I remember this as a child? Um, she actually diagnosed my father with a gallbladder illness, um, a gallbladder disease for which he eventually needed to have his gallbladder removed. Um, and she did this by essentially sort of laying her hands over his body without touching him and running them over his body, and being able to sort of detect energy. And that's actually how she, she diagnosed it. So, you know, it sort of sounds strange for, you know, um, sort of a, I guess, you know, what you'd call a traditionally trained physician like myself to be, you know, given credence to things like this. But honestly, I've, I've seen it work.
It seemed like magic.
Narrator: And it might be magic. While Reiki is considered “alternative medicine” and “pseudoscience” by the western medical establishment, it had a significant influence on Dr. Anderer in his early life, and continues to influence his approach to treating chronic back pain.
Dr. Erich Anderer:
I've come to believe that, uh, there are reasons why some of these modalities, some of these, you know, healing techniques have, have persisted for as long as they have. And yes, there's, I think, traditionally been a little bit more of a dismissive attitude amongst, um, you know, what we would call the more traditional, um, sort of medical establishment to some of these modalities. But, um, but I think that's changing and I think it should change.
I took this really interesting class in fifth grade where, um, and which is actually interesting to think about in fifth grade, you know, my teacher brought in these dead frogs and had us all dissect them. Uh, and I remember pretty much everybody, you know, just being like, oh my God, I don't wanna do that. That's gross. Um, and I was fascinated.
My dad, uh, you know, picked up on this and had me, you know, he took me to a bookstore one day, bought me a copy of Grey's Anatomy, made me sign it. Um, you know, I don't remember the date. It's like sometime in 1985.
I remember actually as a child sometimes sitting there looking at all these structures that I had no idea, cuz they had these beautiful old style, you know, sort of like, you know, almost this like 18th century kind of like art look to them, um, these beautiful plates of, you know, anatomy and various drawings of the body that I would trace over and over again. And, uh, in retrospect, now that I think about it, which is funny, given what I ended up going into, you know, which is neurosurgery, pretty much all the drawings that I had done, all the drawings that I copied were drawings of parts of the brain. So I remember drawing the cerebellum and the cortex and the hippocampus, and uh, and, uh, so clearly there was something about that that, that drew me as a child. Um, and that still continues to interest me, obviously, to this day.
It's sort of like magic the way, the way body, the body seems to work, the way that the brain, which is this, you know, you would think you kind of static group of neurons, like how does that give rise to consciousness and personality and who we are? I mean, to me it's, I mean, it still continues to baffle me. But yeah, I would say that sort of the magic of it as a child is what drew me to medicine.
Producer - Keith King:
So you'd say fifth grade frogs, was that the first time medicine kind of entered your, besides the rake? Of course,
Dr. Erich Anderer:
I became a neurosurgeon because of fifth grade frogs. Yeah, absolutely.
Narrator: Education was an intrinsic part of Dr. Anderer’s upbringing. His father was a professor of Eastern Philosophy. His mother was an opera singer. His parents met in college.
Dr. Erich Anderer:
but by and large, uh, they were fairly hands off actually for parents of that era. And, uh, and, and, you know, but it was understood. There were just sort of this undercurrent of the importance of, of education, the importance of the acquisition of knowledge, but also how to apply it in the real world. So they were very against like, you know, using knowledge and gaining knowledge in the abstract people that were more about style than substance. Like, they were very much about gain the knowledge, but what are you gonna do for the world.
Are you working to your potential? They would say that to us all the time. Um, not necessarily battering, you know, this whole idea of you need to get a's, but you need to be working to your potential. And the, and that meant for them, um, are you using your knowledge and your skills and your talents for good to help other people.
That was instilled in us at a young age. Um, and that for me was sort of what education meant.
So in college I ended up studying philosophy. And I think that part of that was, I mean, the fact that I loved reading and I loved, I, you know, I, I did love the sort of, you know, the dissecting of ideas and the way that ideas can apply in the real world. There, there was that, um, I think there was also an element of me not necessarily feeling ready to, to, you know, study science and to do well in science classes in college. The honest truth was that I also had a lot of fun in college. And so I honestly don't think I was, you know, really at a point in my life where I was ready to buckle down and to get that “A” in orgo that you needed to get into to medical school. So even though I was always in the back of my mind, um, I, I ended up majoring in sort of East Asian philosophy, um, because of, probably because of that kind of familiarity and falling back onto themes that I thought were, you know, were, were comfortable. Um, even though in the back of my mind it was always percolating that, yeah, I wanna be a doctor.
So, um, I graduated from college with this degree, but then I went back and did a post baccalaureate pre-med, uh, program, which, you know, which you basically take all your science classes in an accelerated fashion and then apply, apply to medical school.
So I was at Columbia for medical school, um, which was great. And actually the, the people that I met there are primarily responsible for my going into neurosurgery. And so I went on and did my training at nyu.
And so, you know, NYU had this reputation for being amazing surgeons, maybe a little bit cowboyish, um, maybe not the people that you'd see like on the cover of the New England Journal, like publishing all the papers and you know, like presenting its Stockholm or something. But the guys that you'd want operating on your brain tumor, if you had one, like that was the reputation of NYU neurosurgery at that time.
I believe there was actually a Rolling Stone article that was written about NYU neurosurgery, um, you know, 20, 30 years ago called, I think it was called Skulls Angels.
So, you know, I entered the program, this sort of fresh faced ideal, you know, you know, sort of, you know, idealist medical student, um, and got thrown right into Bellevue,
Narrator: Bellevue hospital, closely affiliated with NYU Langone Health, is the oldest public hospital in the United States. It is one of the largest hospitals in the US, with a rich history of education and innovation.
Dr. Erich Anderer:
Bellevue, is, you know, this jewel, crown jewel of the New York City hospital system, which has treated, you know, indigent, uh, patients and pa patients that were suffering from various diseases, pandemics, um, you know, back from its inception in the 18th century. And, uh, and that, um, you know, that mission has basically continued to this day. I mean, we're talking about like, you know, the treating smallpox patients like, you know, treating war, you know, victims of war treating AIDS patients. People had no idea what AIDS was, and people were afraid to come within 10 feet of an AIDS patient. Bellevue nurses were the ones that were, you know, there taking care of these people. Um, and, um, and all the way up to, and including Ebola, um, COVID, I mean, if you wanted, you know, where, where do you go to be treated? Um, you know, if you're, if there's some unknown crazy viral illness going around, like where do you want people, people to go? It's Bellevue.
We worked, um, at Bellevue as interns, um, and a lot of us really, you know, had no idea what was going on. We didn't know anything about how to, how to care for patients, how to, how to do anything, um, clinically.
It was, um, a really, really good way to learn about, about medicine, about treating people with amazingly diverse diseases from amazingly diverse backgrounds.
My primary goal in, uh, you know, going through all this training and, you know, working at a place like Bellevue and training at a place like NYU was to come out and, uh, and treat, uh, people in underprivileged areas. That was always sort of my, um, my goal. And I think that was something that had been instilled in me, you know, back to, you know, from my parents, like, what are you gonna do to, you know, what are you gonna do with what you, with what you learn, with what you know, with the skills that you have? You know, and the answer, you know, this, the subtext of all this was always, how are you gonna make the world a better place?
Given that background, that's, you know, the primary reason I ended up in Brooklyn.
VO: You wouldn’t think of Brooklyn, with its close proximity to Manhattan and being part of one of the biggest cities in the country, as lacking in medical specialists. But believe it or not, there are as few specialists per capita in Brooklyn as there are in far more rural parts of the US.
Dr. Erich Anderer:
That's changing. Um, but it means that, you know, for a lot of people that needed high level subspecialty care, they had to leave the borough.
My mission individually was to help bring some of that high level subspecialize care to, you know, people in the borough that they live, so they can be closer to their families, so they can be closer to their support networks. In a place like New York City, I don't think it's fair, or it makes zero sense that somebody should have to leave where they live in order to get, um, high level care.
Narrator: When most people hear the term “neurosurgeon” they think “brain” - brain tumors, brain bleeds, brain injuries… but as it turns out, most neurosurgeons find themselves working on the spine, most of the time.
Dr. Erich Anderer:
It's back pain, it's, uh, disc herniations, it's cervical like neck spine problems. Um, so, um, you know, and, and as I got more into it and, you know, uh, and, and worked in the field more, I mean, I, it was something that I really felt was, um, there was a need for, um, because it's something that so many people have, right? I mean, so, you know, a brain tumor is something that, you know, it's awful and devastating, um, but it's something that doesn't affect a large portion of the population. And so for me, the, you know, back pain, spine pain is something that's so prevalent, and even, you know, at the time, and even now to a certain extent, I think we haven't really fully fleshed out the best way to treat these really, really common problems. And so for me, I really felt like there was a need.
And, uh, and the fact that, you know, to be frank, there were a lot of, there was a lot of spine surgery that was being done at the time that I felt was probably unnecessary. Um, and I think it was by well intentioned, well meaning physicians that just, you know, didn't really know how to treat people that were suffering.
Back pain was a primary, one of the primary drivers of the opioid crisis.
[News Clips]:
“Opioids are now the biggest drug epidemic in American history.”
“Around 17 million Americans live with debilitating chronic pain.”
“It’s a problem that’s leaving parents grieving and doctors pushing for change.”
Because it was all these people with chronic back pain that was horrible, that was, you know, basically completely devastating to their, to their lives and their livelihood. It's a, you know, one of the most common reasons for lost work days. I mean, the cost of the, the medical system in general is astronomical. And, you know, but for something that was, that devastating and that common, there lacked a really clear way to treat it because there's only a minority of people with back pain, with chronic back pain that actually need surgery.
And it turned out that over time we realized that this was just that opiates were just not the right way to treat patients with this. And so the onus really became on us, became, or win on us, to, to define ways to treat people, and ways to treat people safely.And as I said, you know, even though I am a surgeon and most of what I do is surgery, the vast majority of the patients that come and see me in the office don't need surgery.
And I think back pain more than a lot of things that we treat as physicians, the treatment can sometimes be confounding, can be a little bit nebulous. Um, and so, you know, my impetus for trying to, to find other treatments really was born out of that,
People were thrown into this black box of like, well, chronic pain, not surgical, not really sure what to do with you.
That area that, there were so many people that fell into it, um, really needed to be defined better. And so, you know, I think that was really the impetus for me to, to look at other ways of treating, of treating back pain.
Narrator: With surgery, medication based pain management, and otherwise very traditional methods dominating the treatment template, Dr. Anderer decided to pursue something else… something far from the usual…
Dr. Erich Anderer:
I personally was, uh, interested in yoga just as somebody that was, um, already had an influence of, you know, sort of healing traditions that were maybe kind of, um, you know, maybe considered non-traditional, um, in at least the sort of the strict medical establishment sense.
And, um, and I also, you know, I had a little bit of back issue, you know, myself. And so yoga was something that I, uh, that I really sort of gravitated to, and I thought was, um, was great for me. And I'd read about other people that had had similar issues.
And so this was something that was always kind of percolating in the back of my mind, and I thought, why not try and, uh, and apply this to patients, patients with chronic back pain?
Now, I'm not the first person to think about this. I mean, people have been, you know, talking about yoga in a medical sense for a very long time.
And if you look at the tradition, like the actual tradition of yoga, it goes back hundreds of years. I mean, centuries. So, um, but what I needed was somebody that really knew something about that and about that field, um, to kind of help maybe bring that sort of from the, the public sphere into the more kind of like traditional medical establishment so that we can have other doctors and other people that worked within the medical establishment, um, buy into it.
[Eddie Stern]: “Greetings. My Name Is Eddie Stern and today we’re gonna talk very briefly about back pain, and do a few yoga asanas for back pain relief.”
Dr. Erich Anderer:
Eddie Stern, who is, um, probably the premier ashtanga yoga practitioner teacher in the Western hemisphere. And, uh, you know, he's somebody, I think he taught like Sting and Gwyneth Paltro how to do yoga.
But he is also somebody that, um, is very serious about the practice of yoga and about its, its healing qualities and also wants it to kind of come out of this sort of nebulous, you know, like, well, you know, we think it's good for you because of, you know, your, your chakras and this kind of thing. And you know, again, not to denigrate that necessarily, but like, I think what he really wanted to do was then to bring this into something that was a little bit more concrete and sort of speak the language of medicine.
In his estimation, and in mine as well, it is a, it's, it's a, it's a, it's a medical therapy as well. It can be. And so in order to do that, you kind of have to speak the language, which in the medical field is data. So without data, no doctors are gonna prescribe yoga for back pain, and no insurance companies are gonna pay for doctors to prescribe yoga for back pain.
So they'll pay for Percocet to treat back pain, but they won't pay for yoga. And the reason is because it's, there's no data or there's not enough data. And so most of the data surrounding yoga ends up being, you know, retrospective. So like, you know, descriptive studies or associative studies, um, that are fine. Um, but that don't generate the type of strong data that you need in order to compel people to say like, Hey, you know, this is, this is something that needs to get treated.
Narrator: Strong data. That’s what’s needed to move Yoga onto the list of prescribable treatments for back pain of all kinds. So, that’s what Dr. Anderer and his team are doing.
Dr. Erich Anderer:
we're basically working on a, a prospective study, um, that will look at people in this chronic back pain category that don't need surgery and will randomize them to, um, the usual care group, which is basically sort of physical therapy, medication injections.
Um, that's usually what happens, uh, to a specific yoga protocol that, uh, that Eddie Stern had devised for, uh, for patients with back pain.
We're studying this as a way of, of treating people with, with chronic pain in the hopes that we would generate the data, uh, with a, with a high quality study, and then, um, you know, add to the conversation that this is something that should be considered as part of the treatment by traditional medical doctors for back pain.
Narrator: Dr. Anderer’s main objective isn’t just reporting strong data… he’s also up against the cultural division between the pro-yoga community and the medical establishment.
Dr. Erich Anderer:
So I think one of the hurdles that we've had to overcome, uh, over time is, you know, and I'll, I'll just say I think it's probably like, you know, misperception, maybe even a mistrust on, on either side, um, of the divide, so to speak, um, between, you know, the traditional medical establishment and the, um, what we'd consider sort of the complimentary, um, treatment modality. So things like within the yoga world. Um, I think that, you know, and I've, I've seen, um, you know, a lot of distrust amongst, amongst that, um, you know, the people within that world for physicians, for the intervention based, um, you know, like the, the, the medication invention intervention surgery based, um, way in which, you know, the traditional establishment kind of goes about their business. Um, and on the flip side, I've seen, you know, people within the medical establishment talk about everybody within yoga as being, oh, they're like, you know, they believe in crystals and woo woo and all this kind of stuff, and neither of those things are true.
Um, and obviously, uh, both have a lot, uh, to contribute, I think, to the discussion on how, how we get people better. And I think that's what really appealed to me about working with Eddie Stern, because not only is he somebody that has a significant amount of credibility within the yoga world, and is somebody that's a very serious practitioner of very traditional yoga, um, but he is also somebody that values science, that values physicians and, uh, and that values, you know, validating these, uh, his, his modality yoga as being really what it is, which is a viable treatment option for people.
Chronic pain… it's something that, you know, a lot of people end up having at some point. Um, and anybody that's had chronic pain, and I would say specifically chronic low back pain, um, anyone that has had that can attest, I mean, it's something that's really life altering.
Narrator: Chronic pain is one of the most difficult things to treat, as it doesn’t just dissipate as an injury heals, for example… or as your immune system finishes fighting an illness. It’s a neurological condition disassociated from any specific physiological issue… and it affects every part of life.
Dr. Erich Anderer:
It changes your perspective on everything, you know, as I mentioned before, it's one of the top causes for lost work days. Beyond that, it also causes people, I think, a significant amount of psychological distress. I'd say more than a lot of types of pain. There have been studies on this where they've linked.
Back pain to various psychological conditions, depression and all kinds of other sort of psychological diagnoses. And I think it's because there's something about back pain that's so destabilizing. And I mean that literally and figuratively. People feel like they can't stand up sometimes, right? So there's the literal destabilization, but then there's something too about, you know, the fact that their whole worldview changes because they can't do the activities of their basic daily lives… like, you know, sitting on a toilet, getting out of bed in the morning, walking their kids to school, things like that. Whereas normally people take it for granted they can do those things without pain.
So. It's something that for a lot of people can be extremely distressing and not just for the reasons of the pain itself. There's something about chronic pain where it almost becomes embedded in your neural networks. For example, there is the perception of pain, right? That you get from, you know, you hit your thumb with a hammer and then, you know, your thumb hurts, sends a signal up through your spinal cord, which will tell you which part of your body is hurting. And that signal will get sent to your brain, perceived as, I got hit in the thumb, my thumb hurts. There are people for whom that initial response evokes a response that lingers, where it sort of becomes almost like a feedback mechanism, where the people can continue to feel pain in a certain spot, after the original impetus for that pain has basically gone away.
And so that's kind of how chronic pain gets borne out. It almost becomes embedded in your neural networks and ultimately sort of fed into the brain.
I say this to my patients sometimes, and I mean to be controversial when I say this. Sometimes I'll tell them things like, the pain is in your head, but let me explain what that means. And then I'll go through the whole thing.
So, in some sense, all pain is in your head, and in fact, there are people that have treated pain with techniques that are kind of indirect, that just work on those relay pathways. So, people have done things like deep brain stimulation, where they put electrodes into the brain itself, or have, you know, a more common treatment would be a spinal cord stimulator, where you actually lay something on the spinal cord, an electrode on the spinal cord itself, which sends signals into Sort of the back portion of the spinal cord where those nerves get relayed up from your lower body into your brain, and it almost confuses your body into thinking that there's no pain.
The fact that a lot of that pain can be treated with a disruption of these neural pathways shows the extent to which chronic pain can really actually become. It's almost like a neurological. pathway phenomenon. So when I talk to patients sometimes about this, they'll say things like, you know, Oh, well, I have back pain. It's from this L45 disc. And so usually what I'll do is I'll kind of back up a little bit and I'll talk to them about what a disc is, what discs do and the fact that that disc may actually have nothing to do with their pain. And it was actually something that, and this is not anyone's fault. I mean, this was propagated by physicians for a long time.
And I think that as time has gone on and as our knowledge has sort of developed, I think that we're sort of more on the side that most disc herniations actually don't cause back pain. And the reason for that is they've done a lot of studies where people have gotten MRIs for different reasons and they'll see people with horrible disc herniations that have zero symptoms because these people got MRIs for other reasons, right?
So they'll have a big disc herniation, no symptoms. And conversely, there's also a lot of people out there that have horrible back pain and pristine MRIs, like normal MRIs. And this is the thing. So the majority of people with chronic back pain don't suffer from something structural. In other words, there is nothing structural to work on surgically that will fix it.
I spend a lot of time talking to my patients about ways of conceiving of their pain, and this is kind of the reason why I think certain psychological therapies actually work for chronic pain. Not just yoga, but a lot of other modalities have actually tried to treat this as well. So there's, you know, mindfulness based stress reduction, there's cognitive behavioral therapy, there's a lot of other treatments becoming more popular.
Because I think there's this recognition that chronic pain is not always something structural, but that there's two parts to it, and we have to fix both the body part and the mind part.
Narrator: For patients, Dr. Anderer may not be what they expect. When you go see a surgeon, you expect to discuss what surgical options could fix whatever the problem is… More and more, Dr. Anderer does his best to find a solution that doesn’t include surgery at all.
Dr. Erich Anderer:
There's a lot of people out there that, that have this perception that there's something external to them that's gonna fix the problem.
I'll have somebody come in and talk about back pain and, and, you know, almost be disappointed that I'm not offering surgery. Um, and the, the reality is honest, I think that I'm doing them a favor, right? Because, you know, by doing surgery, which, you know, and again, for only a small minority of people, is that really gonna work? What I'm really doing is I'm helping them to kind of, um, participate in their own recovery,
So for example, like I work in, in Brooklyn and Bay Ridge, Brooklyn, and I'll have, you know, big burley, like electricians coming in, being like, “what are you talking about? I need yoga. Like, I mean, how's yoga gonna help my back?” Right? And so I'll go, I'll prescribe, I'll tell 'em, look, I need you to try this for like a few weeks. See how it, see how it goes. Come back. I bet people come back and be like, “you know, doc, you were right. It worked.” So it's, it's, a lot of it is about, you know, I think getting people to realize that, um, you know, there aren't always structural problems, not something wrong with them a lot of times. And what I mean is that like, not something wrong with the, the motor, with the engine. Like, there's not something that has to be like, kind of, you know, tweaked or fixed. A lot of it has to do with, you know, you getting, uh, getting back in touch with what makes you healthy, what makes you tick, the things you like doing, whatever it is you like doing, get back to them.
There's a lot of data on people with back pain, and the ones that do the best are the ones that get back to their normal activities the soonest.
Narrator: If you let back pain become your norm, it will be your norm. If you do everything you can to get back to the life you had before back pain, it will be less and less a part of your life. Sure, Dr. Anderer could fix your spine or other neurological problems, but perhaps more effectively, with yoga and other alternatives, he could help you help yourself.
Dr. Erich Anderer:
So I think we actually really are in an exciting time in medicine, and I'm looking forward to a time when Yoga, Reiki, Tai Chi, acupuncture … all these different modalities are sort of spoken in the same breath with surgery, medication… the typical “western medical establishment” type of treatment modalities… because I think that where we cover our blind spots and really where we meld our strengths is where the future is really bright for our field, and by extension, our patients.
Narrator: Vital Signs is a co-production of NYU Langone Health and SiriusXM. The podcast is produced by Jim Bilodeau, Jennifer Hofmann, and Keith King. This episode was written and sound designed by Jim Bilodeau. SiriusXM’s executive producer is Beth Ameen. Don’t miss a single episode of Vital Signs and subscribe for free wherever you listen to podcasts. To hear more from the world-renowned doctors at NYU Langone Health, tune into Doctor Radio on SiriusXM channel 110. Or listen anytime on the SXM app. To get in touch with our production team, email VitalSigns@siriusxm.com. For the Vital Signs podcast, I’m Rose Reid. Join us next time as we bring you stories of medicine made personal.